Hospital Negligence: How Not To Be The Next Victim

Luke Metzler

ISSUE 19

SUMMER 2026

HEALTH LAW

To see the supplemental infographic for this article, click here.

I. INTRODUCTION

Hospitals are dangerous places. Studies have long confirmed a medical malpractice epidemic in the United States. Current research shows that 440,000 people die every year in hospitals as a result of preventable medical mistakes.¹ This is not a result of healthcare providers’ mistakes. Instead, it stems from institutional system failures that dominate many hospitals throughout the country. To rectify this problem, we need to focus not only on doctor and nursing negligence, but also on the institutional failures that are the root cause of much unnecessary harm suffered from preventable mistakes.

The American College of Healthcare Executives (ACHE) is the professional society for those managing the very hospitals in which preventable errors occur. Many hospital executives are members, fellows, and even chairpersons in ACHE. The organization has an abundance of patient safety literature available to its members. One book available to all ACHE members is Matthew Lambert’s “Leading a Patient-Safe Organization.” Explaining the role of system failures in preventable harm, Lambert writes:

Thinking systematically about medical error is recognizing that relatively few mistakes can be attributed solely to individual actions. When focusing on reducing medical error, the entire organization should be viewed as a system that operates and interacts in complex ways. It includes physicians, nurses, employees, equipment, policies, procedures, physical plant, and many other components.²

Lambert makes it clear that when analyzing the cause of any severe injury, it is imperative to note the systems in place, their interaction, and how the systems failures lead to the injury at hand.

As a related inquiry, hospitals are governed by  federal, state, and other regulations in an effort to keep patients out of harm’s way. Some healthcare systems make the absurd argument that policies and procedures are “only guidelines”; however, evidence suggests otherwise. To effectively ensure safe care, healthcare providers and administrators must be intimately familiar with the standards set forth by the federal, state, and other regulations governing patient safety. In order to protect the rights of those injured by medical malpractice, trial lawyers must be intimately familiar with the established regulatory framework that delineates and governs these standards. 

Three important factors lie at the heart of a healthcare system disaster:

(1)        Failure of training (i.e., competence, supervision);

(2)        Failure of protocol (i.e., policies, procedures, and guidelines); and

(3)        Failure of communication (i.e., competence, policies, procedures and guidelines).

Looking at the institutional framework, these general failures are likely present in virtually any preventable medical injury. These systemic failures represent a failure to adhere to the duties set forth by the regulations mentioned above. Two things must be kept in mind when exploring these issues. First, the regulations are critical. Second, most adverse outcomes are the result of failures at virtually every level in the hospital organization. This is a systemic problem at hospitals and not simply a matter of a “bad apple” nurse who does not have their eye on the ball. We must focus on the system failures.

As patients and family members, it is paramount to understand the inner workings of hospital systems and advocate for transparency and accountability within the hospital hierarchy. This ensures that you or a loved one receives appropriate care and prevents becoming the next victim of a hospital system failure.

II. HOSPITALS ARE DANGEROUS PLACES

The following studies are largely historical, but imperative to keep in mind. It is important to determine who at the hospital is responsible for understanding patients’ safety problems. The nurses, nurse manager, nursing director, CNO, and hospital CEO share a duty to protect patients. It is important to determine who at the hospital is responsible for understanding patients’ safety problems. Accordingly, counsel should also determine who at the hospital is responsible for keeping up with the patient safety literature. This is the reason patients go to the hospital instead of a Holiday Inn Express.

A.    California Medical Insurance Feasibility Study

The Medical Insurance Feasibility Study, conducted in the 1970s, was one of the first large studies of hospital records looking at hospital errors.³ The California Hospital Association and the California Medical Association sponsored the study in support of their own tort reform efforts. At the time, California was in the midst of a perceived medical malpractice insurance crisis. The study aimed to test the feasibility of going to a no-fault system of medical malpractice compensation for injuries and death. Researchers expected the frequency and severity of malpractice to be a minor problem. Moreover, researchers expected the study to show that no-fault systems would cost substantially less than the premiums paid by hospitals and doctors for medical malpractice insurance.⁴

The results defied expectations. The Medical Insurance Feasibility Study found that healthcare institutions and providers  injured one out of every twenty hospitalized patients. Of those, one out of ten patients died from the injury. In analyzing the data, this meant that in 1974, some 140,000 patients were injured in California, 14,000 of whom died as a result. The study also concluded that one out of every six medical injuries was caused by malpractice. The authors found a positive correlation between the severity of the injury and malpractice. Four-fifths of the most severely injured patients were injured by medical malpractice.⁵

B. The Harvard Medical Practice Study

The next major study based upon hospital records of medical injuries caused by medical malpractice was the Harvard Medical Practice Study.⁶ The State of New York commissioned the Harvard Medical Practice Study to evaluate medical injuries and methods of compensating injured patients in the mid-1980s during another malpractice insurance crisis. The New England Journal of Medicine published the results of the study in three parts under special article status.⁷

Part One of the Harvard Medical Practice Study “estimated the incidence of adverse events, defined as injuries caused by medical management, and the sub-group of such injuries resulted from negligent or substandard care.”⁸  The results showed that adverse events occurred in 3.7% of the hospitalizations, and 27.6% of adverse events were due to negligence. The researchers found that 70.5% of the adverse events caused a disability lasting less than six months, 2.6% caused permanent disability, and 13.6% caused death. Like the California Medical Insurance Feasibility Study, the Harvard Medical Practice Study established that the percentage of adverse events attributable to negligence increased as the severity of the injury increased. The Harvard study concluded that out of 2,671,863 patients, there were 98,609 adverse events, 27,179 of which involved negligence.⁹  

Part Two of the Harvard Medical Practice Study analyzed adverse events and their relation to error, negligence, and disability. The authors found that drug complications were the most common type of adverse event (19%); wound infections were second (14%); and technical complications, third (13%). Operative procedures accounted for 48% of the adverse events. However, adverse events during surgery were less likely to be caused by negligence (17%) than in non-surgical events (37%). The proportion of adverse events caused by negligence was highest for non-invasive therapeutic mishaps (77%), diagnostic mishaps (75%), and mishaps in the emergency room (70%).¹⁰

Part Three of the Harvard study looked at the other side of the equation. The Harvard researchers identified patients in their sample who filed malpractice claims against healthcare providers. They compared those results with their findings based on their review of those records.  The researchers then matched their results with statewide data on medical malpractice lawsuits. The Harvard study concluded that the vast majority of patients injured by medical negligence did not make a claim.¹¹ 

C. The Utah and Colorado Study

The Harvard Medical Practice Study stirred some debate. As early as 1993, some healthcare safety experts extrapolated from the Harvard study to suggest that 180,000 people per year die in the United States from a healthcare provider-caused injury.¹²  Critics argued the findings from the Harvard Medical Practice Study might be inaccurate because they were limited to one year in New York. Although the findings were consistent with the California Feasibility Study, the Harvard Medical Practice Study had not been replicated in a large-scale study in the United States. Accordingly, the Utah and Colorado study sought to determine whether the Harvard study findings were similar to those of other states at different time periods.

The study concluded that the incidence and types of adverse events found in Utah and Colorado in 1992 were similar to those found by the Harvard Medical Practice Study from New York in 1984. Adverse events occurred in 2.9% of the hospitalizations in each state. In Utah, 32.6% of the adverse events were due to negligence. In Colorado, 27.4%were due to negligence. Death occurred in 8.8% of the negligent adverse events.¹³ 

D. Institute of Medicine Report

The National Academy of Sciences is a private, non-profit society of distinguished scholars engaged in scientific and engineering research. The National Academy of Sciences established the Institute of Medicine (IOM) in 1970 to examine public health policy  and advise the federal government.¹⁴ The IOM initiated the Quality of Healthcare in America project in June of 1998. The project sought to develop a strategy to create, at a minimum, a threshold improvement in healthcare quality over the next ten years.¹⁵ In 1999, the institute published its first report, entitled: To Err is Human: Building a Safer Healthcare System.¹⁶ In its report, the IOM studied literature on the frequency of healthcare errors, the factors that contribute to their occurrence, and their cost.

The IOM looked at four questions:

1.        How frequently did the errors occur?

2.        What factors contribute to errors?

3.        What are the costs of errors?

4.        Are public perceptions of safety in healthcare consistent with the evidence?¹⁷ 

The IOM concluded that between 44,000 and 98,000 Americans die from preventable medical errors in hospitals each year.¹⁸  Importantly, the IOM acknowledged that this data likely underestimated the occurrence of preventable adverse events.

The IOM found that the licensing and accreditation processes of healthcare providers and organizations focused little attention on safety issues. Even minimal efforts for change are met with resistance from healthcare organizations and providers. The researchers found that the decentralized and fragmented nature of the healthcare delivery system contributes to unsafe conditions. The IOM found that the context in which healthcare is purchased in the United States further exacerbates the problem. Group purchasers have made a few demands for improvement in safety. The IOM concluded that a comprehensive approach to improving patient safety is needed.¹⁹  The IOM made a series of recommendations to that end.²⁰ 

The IOM report created a stir. In response, President Clinton established the Quality Interagency Coordination Task Force to evaluate the IOM’s recommendations,  identify and respond to threats to patient safety, and reduce medical errors.²¹ In 2000, the Task Force presented its report: Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact.²² The Task Force reported that medical errors were “[a] National Problem of Epidemic Proportion,”²³ and research showed that the rate of healthcare errors is far higher than the rate of error in other industries.²⁴ It looked at the epidemiology of medical errors, adverse events, and medical products’ inadequacy or misuse.²⁵ The Task Force also found that the current preventative error programs were insufficient.²⁶  Moreover, the Task Force concluded that there was a “general lack of awareness” about the problem.

E. Healthgrades Quality Study

The Agency for Healthcare Research and Quality (AHRQ) became the lead agency for the federal government on healthcare quality. To better track medical errors, the agency developed and released a computer program that included a set of Patient Safety Indicators (PSI). PSIs were specifically designed for screening hospital administrative data for incidents of concern related to patient safety.²⁷ HealthGrades, Inc. took the Agency’s Patient Safety Indicators software and applied it to approximately 37 million Medicare discharges. In 2004, HealthGrades released its study: HealthGrades Quality Study: Patient Safety in American Hospitals.²⁸ This was the first study to look at the potentially avoidable mortality and the cost impact of patient safety incidents using the PSI’s across U.S. hospitals, among the most concentrated at-risk population, Medicare patients.²⁹ The report was shocking. The authors concluded that their data supported the IOM’s report, and the findings from other studies showing that medical errors and injuries from them are epidemic in the United States.³⁰ Healthgrades found that despite ”shocking and widely publicized” statistics on preventable deaths due to medical errors, there were no improvements in patient safety since the publication of the IOM’s report five years earlier. Instead, they found the previous studies had underestimated the number of deaths caused by preventable medical errors.

F. Recent news: “Medical error—the third leading cause of death in the US”

More recently, in an article published in The BMJ, researchers from Johns Hopkins University analyzed prior studies on medical errors and concluded that there was a mean rate of death of 251,454 per year since the 1999 IOM report. When read in conjunction with CDC rankings of causes of death, medical error is the third most common cause of death in the US.³¹ The authors stated that their data understated the true incidence of death from medical error. The studies analyzed only inpatient hospital deaths and did not account for deaths not associated with specific ICD billing codes. Recognizing and reporting medical errors is essential in the process of improving healthcare. Data from the science of improving safety should be standardized and shared.³² Finally, the authors opined that strategies  reducing medical errors resulting in death should be established in 3 steps: (1) “making errors more visible when they occur so their effects can be intercepted,” (2) “having remedies at hand to rescue patients,” and (3) “making errors less frequent by following principles that take human limitations into account.”³³  Currently, the patient safety statistics are followed by a number of organizations. Most administrative personnel are familiar with Leapfrog.³⁴ 

III. BIRTH INJURIES AND OBSTETRICAL COMPLICATIONS

Unfortunately, the risk of being swept into the medical malpractice epidemic in hospitals is highest during the single human moment deserving of the most joy, childbirth. The most common reason for hospitalization in the United States is childbirth, accounting for nearly 1,195 per 100,000 hospitalizations.³⁵ Nearly one-third of all births in the United States are cesarean sections, making cesarean section the most common surgical procedure.³⁶ In 2018, there were 3,788,500 births in the United States.³⁷ 

Not surprisingly, the number of errors and complications associated with childbirth is astounding. The vast majority of stays for both vaginal delivery and C-section involve at least one complicating condition (91.3 percent of vaginal delivery stays; 99.9 percent of cesarean section stays).³⁸ Further, experts suggest that cerebral palsy results from 2–3 births/per 1000 a year. While some debate the cause of cerebral palsy and other neurologic injury manifesting at or about the time of birth, no one seriously disputes the enormity of the injury to the children and families involved, as well as to society in general.

According to ACOG, “more women die in the US from pregnancy-related complications than in any other developed country” and “between 2000 and 2014, there was a 26% increase in the maternal mortality rate.”³⁹ 

Further, between 2006 and 2015, trends were identified showing an alarming increase in the rates of maternal mortality morbidity, specifically:

• The rate of severe maternal morbidity at delivery—as defined by 21 conditions and procedures–increased 45 percent from 2006 through 2015….

• Severe maternal morbidity was highest among women aged 40+ years and lowest for those aged 20–29 years ….

• Compared with other deliveries, those involving severe maternal morbidity were more likely to be in the youngest and oldest age groups, paid by Medicaid, and from lower-income communities.

• Rates of acute renal failure, shock, ventilation, and sepsis at delivery more than doubled between 2006 and 2015. 

• Deliveries involving severe maternal morbidity were also more likely to occur at hospitals that typically have a mission to serve vulnerable populations and at hospitals in the Northeast and South, as compared with all other deliveries.

• Black women, Hispanic women, and women of other races/ethnicities were overrepresented among deliveries involving severe maternal morbidity, as compared with White women.

• Although deaths decreased for all races/ethnicities, in-hospital mortality was 3 almost times higher for Black women than for White women in 2015 (11 vs. 4 per 100,000 deliveries).⁴⁰  

  
  

Examples of conditions of maternal morbidity (defined as “unexpected outcomes of labor and delivery that result in significant short or long term consequences to a woman’s health”) include: need for blood transfusion, acute renal failure, shock, ventilation, aneurysm, adult respiratory distress syndrome, disseminated intravascular coagulation, hysterectomy, cardiac arrest/ventricular fibrillation, temporary tracheostomy, conversions of cardiac rhythm, amniotic fluid embolism, sickle cell disease with crisis, pulmonary edema/acute heart failure, air and thrombotic embolism, eclampsia, puerperal cerebrovascular disorders, acute myocardial infarction, severe anesthesia complications, heart failure/arrest during surgery.⁴¹ 

Ultimately, for us, the question is “what is being done at a systemic level to address these already well-known, well-publicized failures of the U.S. healthcare system towards its female patients. What can we do to prevent becoming another buried data point in an inexcusable, dangerous healthcare system?”

IV. SYSTEMS FAILURE

As mentioned, the American College of Healthcare Executives views patient safety and preventable errors as systemic issues. This is consistent with the thinking behind the Joint Commission root cause analysis. It is also consistent with and overlaps the duties set forth by the CMS Conditions for Participation, Joint Commission Standards, and the various states’ nurse practice acts. Focusing on a systems analysis will shift case analysis in several ways. First, the cause will focus on a large corporate entity, opposed to an individual healthcare provider. Second, the analysis will move the relevant timeline back months or even years prior to the care at issue. Third, it will provide a legitimate basis for discovery and to depose those involved with the administrative change of command, including the CEO.

The American College of Healthcare Executives has its own professional journal, Healthcare Executive. Indeed, it has additionally published Leading a Culture of Safety: a Blueprint for Success. The organization has its own code of ethics. In fact, the American College has its own safety pledge, which it encourages members to take: “I pledge to lead for safety, to model the values and best practices to create and sustain a safety culture in my organization and to empower other leaders, within and outside my organization, to make safety leadership an imperative.” In an article entitled “The Patient Safety Team: Healthcare Executives Embrace Their Role,” the organization shows the importance of going up the administrative chain. It provides:

The notion of the healthcare executive as a critical patient safety change agent was a rare concept not long ago. It was primarily the clinical staff who worked to ensure safety and patient care administrative – clinical alignment was strengthened, however with the realization that C–suite carries as much accountability for patient safety as the clinical staff does. If you are a healthcare executive, you know that a patient’s safety has become an integral part of your job.⁴² 

The publication Healthcare Executive had a regular section titled “Patient Safety.” Additionally, the American College of Healthcare Executives also has a journal of Healthcare Management. An example of patient safety analysis from a recent issue of that journal is an article entitled: “High Reliability Healthcare, Building Safer Systems Through Just Culture and Technology”.⁴³ These resources are rich in information that establishes a duty of care on the part of healthcare executives to ensure patient safety. 

Patients and loved ones should always consider how the risk of system failures could contribute to an adverse outcome. Knowing all the members of the multidisciplinary healthcare team will ensure the right people are present during important decision-making.

V. CONCLUSION

As mentioned at the beginning, hospitals are dangerous places.  There are numerous standards for hospital and nursing care that derive from the federal and state governments, accrediting organizations, and professional associations. The purpose of these standards at all levels of a hospital’s operations is to promote safe care.  Otherwise stated, they protect patients. When patients are injured because of disregard for these standards, the hospitals must be held institutionally accountable.

As in most circumstances, knowledge of the dangers to patient safety from institutional failures is the first step to avoiding them. Patients cannot rely on hospitals and healthcare providers to openly offer the information without some prodding. In order to avoid becoming a statistic in the long history of preventable adverse outcomes in the US healthcare system, patients and loved ones must learn of these dangers and advocate for transparency, accountability, and C-suite top-down approach to patient safety.

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Suggested Citation: Luke Metzler, Hospital Negligence: How Not To Be The Next Victim, ACCESSIBLE LAW, Summer 2026.

HOSPITAL NEGLIGENCE- HOW NOT TO BE THE NEXT VICTIM.pdf

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Sources:

[1] John T. James, A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care, 9, J. Patient Safety 122, 127 (September 2013). See, HealthGrades, Patient Safety In American Hospitals, July 2004 at 1; see NBC News, 195,000 U.S. deaths blamed on hospital error (July 28, 2004, 7:52 AM), https://www.nbcnews.com/id/wbna5536730; see also, HealthGrades, HealthGrades Quality Study: Third Annual Patient Safety in American Hospitals Study, April 2006 at 1; Healthgrades, Healthgrades Quality Study; Fourth Annual Patient Safety in American Hospitals Study, April 2007 at 1.

[2] Matthew J. Lambert III, Leading a Patient-Safe Organization, Health Admin. Press (2003).

[3] Don Harper Mills, Medical Insurance Feasibility Study, 128 West J. Med. 360, 360–65 (1978).

[4] Tom Baker, The Malpractice Myth 25–27, Univ. of Chi. Press (2005); see generally Mills, supra note 3.

[5] Don Harper Mills, Medical Insurance Feasibility Study, 128 West J. Med. 360, 363–65 (1978).

[6] Harvard Medical Practice Study, Patients, Doctors, and Lawyers: Medical Injury, Malpractice Litigation and Patient Compensation in New York: The Report of the Harvard Medical Practice Study to the State of New York 1 (Harvard University, 1990).

[7] Troyen A. Brennan, et al., Incidence of Adverse Events and Negligence In Hospitalized Patients–Results of the Harvard Medical Practice Study I, 324 New Eng. J. Med. 370, 370–76 (1991); Lucian L. Leape, , et al., The Nature of Adverse Events in Hospitalized Patients–Results of the Harvard Medical Practice Study II, 324 New Eng. J. Med. 377, 377–84 (1991); Russell Localio, et al., Relation Between Malpractice Claims and Adverse Events Due To Negligence, 325 New Eng. J. Med. 245, 245–251 (1991).

[8] Brennan, supra note 7, at 370.

[9] Id.

[10] Lucian L. Leape, et al. Preventing Medical Injury, 19 Quality Rev. Bull. 144, 144–49 (1993). 

[11] Localio, supra note 7, at 245.

[12] Leape, supra note 7, at 377.

[13] Eric Thomas  et al., Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado, 38 J. Med. Care 261 (2000).

[14] Linda T. Kohn, et al, To Err is Human: Building a Safer Health System 1 (2000) (citing Martin, Joyce, et al, Births and Deaths: Preliminary Data for 1998, 47, 25 National Vital Statistics Reports, October 5, 1999 at 1).

[15] Id. at xi.

[16] Id. 

[17] Id. at 29.

[18] Id. at 31.

[19] Id. at 3.

[20] Id. at 69, 87, 111, 133, and 156.

[21] Quality Interagency Coordination Task Force, Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact: Report to the President (Washington: QuIC Task Force, 2000).

[22] Id.

[23] Id. at 1.

[24] Id. at 34.

[25] Id. at 37. 

[26] Id. at 41. 

[27] Agency for Healthcare Research and Quality, Patient Safety Indicators, Version 2.1, Revision 1 (March 2004).

[28] See HealthGrades, Patient Safety In American Hospitals, supra note 1.

[29] Id. at 7.

[30] Id.

[31] Martin A. Makary, Medical error—the Third Leading Cause of Death in the U.S., BMJ 2016; 353; i2139 (2016).

[32] Id.

[33] Id.

[34] Leapfrog Hospital Safety Grade, Leapfrog Group, https://www.leapfroggroup.org/data-users/leapfrog-hospital-safety-grade (last visited Apr. 9, 2025).

[35] Jennifer Podulka, et al., Hospitalizations Related to Childbirth, Agency for Healthcare Research and Quality, https://hcup-us.ahrq.gov/reports/statbriefs/sb110.jsp (2011).

[36] Kamila Mistry, et al., Statistical Brief #211 Variation in the Rate of Cesarean Section Across U.S. Hospitals for 2013 (HCUP, AHRQ 2016).

[37] Brady E. Hamilton, et al., Births: Provisional Data for 2018 (Vital Statistics Rapid Release Report No. 007, May 2019).

[38] Jenifer E. Moore,  et. al, HCUP Statistical Brief #173 Complicating Conditions Associated with Childbirth, by Delivery Method and Payer 2011 (Agency for Healthcare Research and Quality, May 2014).

[39] Martha Bebinger, ‘A National Embarrassment’: Maternal Mortality Rises In The U.S., WBUR (Aug. 11, 2016), https://www.wbur.org/news/2016/08/11/maternal-mortality-rate-rises.

[40] Kathryn R. Fingar, et al., HCUP Statistical Brief #243 Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Moribidy, 2006–2015, AHRQ (2018), https://www.hcup-us.ahrq.gov/reports/statbriefs/sb243-Severe-Maternal-Morbidity-Delivery-Trends-Disparities.jsp.

[41] Id.

[42] Birk, S, The Patient Safety Team: Healthcare Executives Embrace Their Role, Healthcare Executive 13 Sept/Oct 2011 at 1.

[43] J. Adelman, High Reliability Healthcare: Building Safer Systems Through Just Culture and Technology,  64 J. Health Mgmt., 137, 137–141 (May/June 2019).